benign prostatic hyperplasia - semmelweis
TRANSCRIPT
Benign Prostatic Hyperplasia
Certified Clinic
Péter Nyirády
Certified Training Centre for Andrology
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Anatomy of the prostate
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Etiology not known
• Less apoptosis estrogenes?
• Changing of stromal-epithelial ratio due to autocrine
reasons?
• Abnormal stem-cell proliferation?
• Changing of Estrogen/Androgen ratio?
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Epidemiology
6000 operations in Hungary per year
Medical treatment in 50000 cases
250- 280000 patients in Hungary
at the age of 60-70
- 70% histologic changes
- 40% clinical symptoms
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Effects of BPH
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S y m p t o m s
Obstructive
• decreased, intermittant flow
• dribbling
• hesitancy
• residual urine Irritative
• Nycturia
• Pollakisuria
• Urgency
• Dysuria
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Diagnostics
• History, (questionaires: IPSS)
• Physical and digital rectal
examination
• Ultrasound transabdominal/ (TRUS)
• Uroflowmetry
• Residual volume (US)
• (PSA), laboratory
Optional
examinations
• Cystoscopy
• Urodynamics
• TRUS
• Biopsy
• X-ray, IVP
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Imaging technology
• Transabdominal/ rectal US
• Prostate volume
• Residual urine
• Pathologic changes in bladder (stone,
diverticuli)
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Uroflowmetry
Stricture
time
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Differential diagnosis Prostate cancer !
Urethral stricture
Bladder stone
Chronic prostatitis
Bladder cancer (!)
Bladder atonia
Meatal stricture
Phimosis
Bladder diverticulum
Cardial decompensation
Diuretics
Neurogen dysfunction after pelvic operations
Parkinsonism
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Therapy
• Watchful Waiting
• Pharmacotherapy
– Phytotherapy
– α- blockers
– 5-α reductase inhibitors
• Operation
– Transurethral (TURP, TUIP,…)
– Open
• Alternative medicine
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Phytotherapy
• Sabal serrulata
• Urtica dioica
• Pygeum africanum
• Hypoxis rooperi
• Cucurbitae pepo
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α-blockers
• First choice if drugs necessary
• Quick effect
• Decreases symptoms
• Increases peak flow
• Other effects (increases erection)
α-receptors
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5α-reductase inhibitors
• Slowly acting but permanent effect
• Inhibits transformation of testosteron-dihydrotestosteron
• Can cause 30% volume reduction
• Effective only over 50 ml Pvol
• Decreases PSA by 40-50%
• Decreases libido and erectile function
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Operation
• Absolute indications of surgical treatment
– Urine retention
– Bladder stone, -diverticuli
– Hydronephrosis
– Renal failure
– Recidive UTI
– Macroscopic haematuria
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TURP - TransUrethral
Resection of the
Prostate
• „Gold standard”
• under 70-80 g
• CAVE TUR syndrome!
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Open adenomectomy
Over 70-90 g
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Alternative (minimal invasive)
technics
• TUIP Transurethral Incision of the Prostate
• TUVP Transurethral Electrovaporisation
• TUMT Transurethral Microwave Thermotherapy
• TUNA Transurethral Needle Ablation
• Stents
• HIFU High-Intensity Focused Ultrasound
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Thank you for your attention!